Archive for the 'Medical' Category

Smoking and Botox — Wishful Thinking and Common Sense

The FDA came out with a report on the negatives of botox injections…

It’s like deja vu, isn’t it?  Where is common sense?

Read this post at About.com, Patient Empowerment.

MRSA: Patients Ignored, Left to Die

(Find an update to this post: MRSA, Victimization and Shooting the Messenger)

In the past two days, I have heard three stories, all related to MRSA and other hospital acquired staph infections, and all relating to heinous — even (in my not-so-humble-opinion) criminal acts on the parts of healthcare providers or politicos.

One story came from a colleague who visited a woman in the hospital. The woman contracted an infection after surgery almost a year ago. She is still in the hospital, on life support, not because of the surgery, but because the infection has just consumed her.

This post has been moved. Link here to find it in its new location.

Why Your Doctor Won’t Help You

Notice that the title doesn’t say “can’t Help You.”  It says “won’t.”  There’s a big difference.

CPT codes are the stuff a doctor’s practice is made from.  I know — you thought patients were the basis for a physician practice, but no, CPT codes are more important than patients — even though I can guarantee that most doctors wish that was not true.

CPT Codes, Current Procedural Terminology Codes, are all those little numbers that show up on the bill you are handed as you walk out of the doctor’s office.  They are supposed to represent every type of task performed in medicine — from a basic check-up, to diagnosis, to administering a shot, to giving a medical test, to the levels of that test, to surgeries, to anything at all.  They are developed by the AMA, the American Medical Association,  and are intended to be the standard by which all doctors get paid, and all insurance reimburses.  The codes are revised regularly, and new codes are developed by an editorial board that represents the membership of the AMA.

Among the most frustrated of patients I hear from are those who can’t get diagnosed.  There can be a number of reasons for not getting a diagnosis, but one of the big problems is that patients can’t find one central person to review all the evidence.  They are sent from specialist to specialist, each looks at his own tests and results, but they don’t look at results from other doctors, except maybe the one who referred the patient. 

I call this daisy-chaining.  Each doctor represents a link to the answer.  Each link might look at the information from the link it is connected to.  But none of those links review information from links they are not directly connected to.

So what does that have to do with CPT codes?  Plenty.  Because the reason they won’t look at the other records is because there is no code for doing so — therefore — there is no way they can get paid (reimbursed by Medicare or insurance) to look at the big picture for a patient.

Why not?  I have theories, and they all relate to money, of course.  The AMA represents the doctors.  One would think that if doctors wanted to do this kind of big picture diagnosing, or review of other’s notes and reports, then the AMA would develop a code for it, right?  So theory #1 is that doctors don’t want to be doing so.  They don’t want to be responsible for that particular task. 

Theory #2 is that why would the AMA waste its time if insurance won’t cover the cost anyway?  And that’s actually the root of today’s blog.  A review of the new codes for 2008 shows that codes have now been developed for doctors who take phone calls or email from patients.  However, the report includes a caveat that says Medicare and insurance companies won’t be reimbursing for them anyway.

So that explains why your doctor won’t do what you wish he would do — take a comprehensive look at all your health challenges, and help you get diagnosed even after seeing a slew of specialists.   They wish they could — but they can’t.  If they can’t get paid, they can’t stay in business.  If they aren’t in business, then what good does it do for anyone?

I do give a bit of credit to the AMA for at least giving their new codes a shot — it’s a start.  Many more are needed.

But what’s really needed is someone to kick the payers in the backside.  They work for US, afterall — we pay taxes and we pay premiums.  So why aren’t they held accountable to reimburse for all those codes? 

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Overcoming the Doctor-Patient War of Words

I seem to have hit a nerve with my post about Dr. Steve Cole’s editorial published a few days ago. Dr. Cole asserted that the reason healthcare costs are going up is because doctors have learned to milk the system in ways related to how they order tests, prescribe meds and other tasks which allow them to use billing codes that get reimbursed by insurance at a higher rate.

Wow! Here are a few of the post outcomes:

  • My blog hits doubled.
  • The number of comments to the post doubled over my highest day previously.
  • Several doctors — those who commented and those who emailed — were ready to shoot the messengers — both Dr. Cole and me!
  • Some doctors agreed with Dr. Cole.
  • Some doctors vehemently disagreed.
  • And patients — always the ones who find themselves at the bottom of the totem pole, once again feel victimized by the whole sorry situation, regardless of how it came about or how it’s being handled.

As your friendly — and peace loving — Every Patient’s Advocate — let me raise a few points and clarifications:

There are many reasons the costs of healthcare are increasing. Dr. Cole offered one set of reasons but certainly not all of them. Others include the wish for private insurance to profit more and more, the too-high costs of drugs, the bad habits of patients which require more care to “fix” them (like smoking, obesity and others), the increasing healthcare costs of an aging baby boomer population, the fact that people are living longer, meaning they need higher priced care longer, the higher costs of advanced technology, and others. One commenter to the blog (justordinaryjoe) took a stab at this master list and did a good job at it.

What truly upsets me — UPSETS ME — is that somehow this translates to a them-vs-us discussion. Doctors VERSUS patients or patients VERSUS doctors. We’ve lost the “and” — and that, to me, is frightening and dangerous. This is not about a conflict. But it is about a loss of trust.

But a patient’s loss of trust in his/her doctor is not the trust that should be lost. The patient AND the doctor should be focusing their lack of trust on the very system that has created it. That’s what is broken — the system of healthcare in America. And it won’t be doctors or patients who can fix it, even though it’s doctors and patients who pay the highest price.

Recognizing that it’s the system — and not the doctors and patients — then we patients must work harder to collaborate with our doctors, and doctors must work harder to collaborate — and respect — patients. Here are some of the ways that can happen:

1. Respect for TIME: Time is money. And the respect for time is one of the biggest violations.

Doctors — PLEASE respect the time of your patients. Give them your 100 percent attention during those brief six or eight minutes you will see them. And don’t make them wait in waiting rooms for more than 10 minutes. After 10 minutes, it is a violation of your patient’s time.

And patients — PLEASE respect your doctor’s time. He can’t make a living (and yes, I’m serious about that) if you impose on his time for more than you deserve. Granted, you are hiring him to do a job for you. But you aren’t paying him out of your pocket — and you just can’t have ALL the time you want — so be concise, be specific, ask targeted questions and move on.

2. Respect for KNOWLEDGE

Doctors — you don’t have a corner on all the knowledge. Please respect that patients know their own bodies better than you do. Don’t try to fit their square problems into your round holes. Understand that the internet does yield ideas for them and be willing to discuss them, even if they seem ludicrous to you.

Patients – your doctor spent up to 12 years gaining the medical education needed to accurately diagnose and treat you. Don’t think that by spending an hour or two on the internet, or by talking to other people, that you can trump that education. Ask for help in translating new information you learn… and do so with….
3. Respect for the COLLABORATIVE PROCESS: Getting to WELL is not one sided.
Doctors — please don’t jump to conclusions. Doctors must work WITH their patients — not AT them. And never EVER (well, OK, hardly ever) tell any patient that a malady is all in her head! (see RESPECT below.)

And Patients — make sure you participate collaboratively, too. Ask questions that allow you to assess possibilities, ask more questions, and arrive at a decision WITH your doctor, not just because your doctor tells you that it’s the “best” answer for you. YOU are the only person who can determine the best answer for you.

4. Respect for DECISION-MAKING

Patients — YOU are the people with the responsibility for making decisions about your own bodies (and, in terms of advanced directives, your own demise.) You need to step up to that plate to do so. Don’t just default to what the doctor recommends. Ask instead for a good review of ALL your treatment options, the pros and cons of each, and then make as objective a decision possible based on that input.

Doctors — don’t abbreviate the list of options you give a patient just because you think others aren’t good options. (And a message to many — don’t try to tell me that doesn’t happen, because even if you don’t do it, you know it happens with your colleagues.)

5. Respect for…. RESPECT

Doctors — working with a patient does not allow you to judge him or her. I wish I had a nickel for every time a patient has said, “The doctor just laughed at me.” or “I was so insulted!” A patient comes to you for help and counsel — not for your judgment. You need to treat that patient respectfully.

Patients – and I’m serious about this — the only time you need to respect your doctor is if that doctor deserves respect. If your doctor laughs at you or insults you, or in some way makes you feel like less than the respect-deserving person you are — say something! And if you can’t muster the ability to say something, then send them a report card and tell them. And — if necessary — find yourself another doctor.

And the bottom line is:
Doctors: please make sure your patients understand and experience the respect they deserve. For most of you, this is a daily occurrence. But we all know that for many, it’s not even on their radar.

Patients: stop expecting your doctors to be gods who can overcome a broken system to help you get the medical attention you need. For most doctors are truly doing the best they can. And it’s up to you to weed out the ones who aren’t — and walk away.

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Want more tools and commentary for sharp patients?
Sign up for Every Patient’s Advocate email tips
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Join Trisha in the Patient Empowerment Forum at About.com
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Or link here to empower yourself at
EveryPatientsAdvocate.com
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10 Things Your Physician Won’t Tell You…

…. and I can’t take credit for them.

Check out this article in Smart Money magazine

You’ll learn from it, as scary as that is.

Then read my commentary here.

Yanking the Cure Rug Out From Under Lymphoma Patients

In the continuing saga of two “miracle” drugs for those who suffer from non-Hodgkins lymphomas… the fifth most common cancer….

I told you six months ago about Bexxar and Zevalin, the two drugs which can treat non-Hodgkins lymphoma but were not being promoted by oncologists in private practice because they cannot, by law, administer it. That means they cannot profit by it. Remembering that American Healthcare is not about health or care, it’s about sickness and money…. we learned then that these drugs must be administered in (usually academic) medical centers because they have a radioactive component to them. So many oncologists provide infusion services themselves, but are not allowed to administer these two drugs, so they don’t tell their patients about them. I remain angry about that subject.

As if that weren’t difficult enough, there is now a new twist to this story, making it even more difficult for lymphoma patients to get this treatment they need — and deserve to have. According to the New York Times, Medicare has decided to reimburse administration of this drug in 2008 at about half the cost of the drug. Medicare made that determination, it says, based on what hospitals have been billing Medicare for the drug — but hospitals dispute that, saying they would never request reimbursement that would cost them almost $10,000 per patient! Patients need only one treatment, but it’s very expensive because the drug itself is very expensive.

Both hospitals and the manufacturers are confused as to how Medicare put together its reimbursement schedule. They believe errors have been made, and that Medicare’s numbers are wrong.

So here’s how this begins to domino….

Find the rest of this post at the new location of the Every Patient’s Advocate blog….


http://trishatorrey.com/2007/12/13/yanking-the-cure-rug-out-from-under-lymphoma-patients/

When Blaming Gets in the Way of Well-being

Last evening I heard from Jack, a man with revenge on his mind. Sadly, Jack’s focus on making sure someone “pays” has moved the real problem, and the person who needs his help the most, to the back seat. It’s a bad situation, and it just breaks my heart.

Jack has a six-year-old son, Max. Two weeks prior to Max’s birth, his mother was diagnosed with a strep infection. When Max was born, he seemed normal and neither the doctors, nor the family were aware of any problems. But within months it became apparent that problems were many. Eventually, bloodwork was done, later a biopsy, and Max was diagnosed with muscular dystrophy.

Jack thinks the hospital, or the obstetrician, or both are at fault for Max’s disabilities. He is doing whatever he can do — afford to do — to prove that point. And that’s why he contacted me — to help him prove that point.

He wants them to pay.

I chatted with Jack for a little while. I asked about the diagnosis, and Jack was unclear about it. He tried to get the Mayo Clinic to study Max, for free, but the Mayo Clinic wasn’t interested. They wanted thousands of dollars to do a workup, and Jack doesn’t have that kind of money. It’s clear there is a dystrophy of some sort, but Jack thinks the diagnosis may be wrong. He couldn’t say why except that one doctor, thousands of miles from where Jack lives, said the biopsy slides are fuzzy.

I asked about the differences in dystrophies. Would they necessarily be treated differently? Could it just be a question of genetics? Jack didn’t know.

I asked Jack about the birth. He mentioned the strep B infection his wife had, but kept insisting that his son was normal at birth.  I looked up Strep B after we got off the phone.  Birth defects are rare, but possible.

I asked about Max’s well-being — is he in school? Is he progressing? But I realized after about the third question that the conversation about Max’s life was being deflected in each case — always to who wouldn’t help and who wasn’t providing the “right” information to Jack.

My eureka moment came when I tried to suggest to Jack that he needed to be contacting the Muscular Dystrophy Association and others who might provide help — and realized that wasn’t the purpose of the call. In fact, Jack’s interest is less about his son, and more about the blame.

I won’t pass judgment on Jack. I can’t imagine having a child with a very difficult disability, and thinking that it might have been the result of a medical mistake at birth.

What bothered me the most was that Jack was so intently focused on the money he might get if he could prove blame — at the expense of his son’s current well-being. If he could only focus some of that intense energy on helping his son grow, and perhaps even thrive, despite his disabilities….

As Every Patient’s Advocate, I get frustrated because sometimes I just can’t help. I don’t have the knowledge or the means or the resources for special cases like this. Not that I can’t provide resources — I can — but not when there is an ulterior motive.

And — I can plead for priorities — as I did with Jack. I asked him not to let go of his fight because someday it may prove to be the right thing to do. But I tried to redirect the fight into something positive for Max. I asked Jack to reprioritize where the bulk of his energy needs to be.

Jack seemed uninterested. I wasn’t able to give him the answers he was looking for. He was pleasant and thanked me, but I could tell it fell on deaf ears.

Blame zaps us and subtracts from the positives. Refocusing that blaming energy can be incredibly cathartic. Max deserves that from his dad.

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EveryPatientsAdvocate.com
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MRSA: Those With Power Aren’t Paying Attention

Two reminders during the past week about MRSA and the real problems facing those who are infected by it — and those who aren’t.

The first was an email from Genevieve who told me about her husband’s experience after knee replacement surgery. Two days after being removed to a rehab center, he began running a fever, and his incision starting turning red — obviously the sign of an infection.

He was transported by ambulance to the hospital where he had the surgery, and the resident on call proceeded to examine his knee — with no gloves on! Genevieve objected — loudly she says — “wait! what if it’s MRSA?”

The doctor turned to her and in a loud voice, exclaimed that MRSA wasn’t the problem everyone thinks it is, and she shouldn’t get so upset! Genevieve, however, insisted he wash his hands and put on gloves before touching her husband again. (you, go, Genevieve!) Fortunately, while there was in infection at the site of the surgery, it was not MRSA.

The second reminder came in the form of an editorial included in Health Leader’s Media by Molly Rowe called MRSA, MRSA Me. She tells about her difficulties this past summer in getting her “spider bites” diagnosed as the MRSA they were, and the ensuing disinterest on the part of her family care doctor when she was later scheduled for knee surgery and they didn’t care about double checking that her infection had, in fact, been healed. You can just imagine what might have happened had the MRSA spread to her surgical site.

Clearly, despite the media attention, despite the 100,000 deaths each year, despite the cost to hospitals of taking care of those who get sick from it — the very people who can make a difference don’t seem to be paying attention! It’s as if they take the concept of transparency (recognizing the problem so they can do something about it) to mean invisibility (if we ignore it, it will go away.)

It’s time those leaders in hospitals, and their staff, became “infected” with whatever impetus is needed to take note and take these infections seriously. Sadly, it will likely require some horrible tragedy — like the loss of a hospital’s CEO or the CEO’s loved one to MRSA — before the people in a position to make a difference will do so.

For now, we patients need to do just what Genevieve did. She proclaimed her dissatisfaction loudly to take care of the present danger. THEN, she got in touch with the hospital’s administration afterwards to complain. She is truly an empowered advocate.

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Kickbacks: Doctors, Pharma, Insurance and Surprise! Patients Caught in the Middle

See if you can get your arms around the following conundrum, which is typical of our dysfunctional American Healthcare System — only this time with a twist. We’ll begin with point-of-view:

Consumers (that’s us patients!): When we need a prescription drug to improve our health, we want the best drug for what ails us, at the lowest price possible. We also want affordable health insurance, with fair co-pays for those drugs.

Physicians: When it comes time to prescribing a drug for a patient, the doctor wants to be sure it’s the right drug with the best chance of improving the patient’s health. Further, the physician is also on the constant lookout for ways to increase his/her income. They are offered money, support and/or other incentives from pharma manufacturers on a constant basis, but this practice has become a real point of contention because it creates a conflict of interest. Now, for many, a possible new income stream has been offered by insurance companies (see below.)

Pharma companies: Are interested in maximizing income. Period. And they will do whatever they can to protect that interest. Their real allegiance is to their stockholders who may also be any of the players mentioned here. The great majority of their income is derived from branded/innovator drugs and they take a huge hit when their patents run out and they begin to compete against generics. They look for ways to reward doctors for prescribing and using their drugs.

Insurance companies: Are interested in maximizing income. Period. And they will do whatever they can to protect that interest. Even the not-for-profits want to maximize their income so they can pay out bigger bonuses to their top people. They are constantly on the lookout for ways to reduce their costs so their profits are larger. When they can get doctors to switch patients to generic drugs, (or when they can get patients to ask their doctors about the possibility) then they can save costs.

Some background:

Read the rest of this post at its new location:

http://www.trishatorrey.com/2007/11/26/kickbacks-doctors-pharma-insurance-and-surprise-patients-caught-in-the-middle/

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Thank a Veteran for Your Medical Care

Yesterday for my radio show I had the pleasure and honor of interviewing a doctor who spent 25 years in the Navy, retired in 2005, and now serves a civilian population at University Hospital in Syracuse, NY with the skills he learned and developed while in the Navy.

A fitting program for Veteran’s Day 2007, don’t you think?

Dr. Ross Moquin retired as a commander, and served during both Iraq Wars, as a spinal and neuro surgeon. The stories he told were a mix of service to soldiers, and humanitarian efforts, too. We contrasted wartime medical care from World War II with how soldiers are cared for today — and what struck me more powerfully than any other message was how tuned in the military physicians are to the needs of the soldiers. For example, understanding that the sooner they see their loved ones, the more quickly they will recover, or at least get stronger.

Of interest to you, my reader, may be the fact that there are procedures and treatments being developed in military hospitals that are then translated to a civilian population. Dr. Moquin gave three examples. One is telemedicine — the idea that a doctor in one location, can walk a doctor through a procedure in another location by using video. Telemedicine isn’t new, but it’s being continually refined, partially in collaboration with the military.

A second area of work is for those who suffer from traumatic brain injuries — like American soldiers who are injured by IEDs (roadside bombs, improvised explosive devices). If a soldier is injured in the head, his/her skull is removed, all the repair work is done, and then once the brain is healed and the swelling goes down – up to a year later – a new skull is fabricated from some special material and only then is it replaced on the soldier’s head. Sounds fabulous — and like science fiction to me!

A third area of work is perhaps the biggest, because it’s more about a culture change and communications. Whereas western medicine in general has always separated spinal surgery and neuro surgery (two distinctly different disciplines even though those two body systems are so closely related.) Now Dr. Moquin tells us that he and others on his team, while in Germany and at Walter Reed Hospital, were working together. There is an organization state-side that is promoting this collaboration called One Spine. All of this can only be of major benefit to us patients.

I hope you will take a moment today — Veteran’s Day — or any other day you may find this blog post — to thank a veteran. Their work to protect our freedom is incredibly important, and today we’ve learned more about how that work reaps benefits in other ways, too.

Here’s the thanking I’m doing today: Among those veterans, I thank my husbandairforce1.gif Butch. Before I met him, he spent 20+ years in the Air Force, living all over the world, protecting those of us going about our business on American soil…. an unsung hero to most, but certainly one of the biggest heroes to me. AND my dad, Richard, who very proudly served in the Army Air Corp, in Japan, as World War II was coming to a close, my favorite among the members of the “greatest generation.”

By the way — you can listen to the interview with Dr. Moquin — it lasts about 24 minutes — I think you’ll enjoy it. 

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. . .This Blog Has Moved!. . .

Where did everything go?

Not far.
We just relocated, that's all.

You can find every post and comment from this blog
-- and plenty more --
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Every Patient's Advocate Blog.

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